BCAN is taking action to help policymakers understand the connection between exposure to burn pits and bladder cancer; and have bladder cancer added as a presumptive condition under the 2022 PACT ACT. To accomplish these goals, we are gathering information to identify veterans who have developed or are concerned about developing bladder cancer due to a potential exposure to burn pits.  Thank you for your willingness to support our efforts by completing this brief survey. All responses will be kept confidential.

*1.What is your connection to the military? Check all that apply.(Required.)

I currently serve in the US military

I am a veteran of the US military

I am a dependent of someone who is/was in the US military (please answer the questions on behalf of the service member)

Other (please specify)

*2.Do you recall being exposed to burn pits during your military service?(Required.)

Yes

No

I don't remember

*3.Are you a Gulf War era and/or post 9/11 veteran?(Required.)

Yes

No

I am not sure

*4.Did you serve in any of these locations on or after September 11, 2001? Check all that apply.(Required.)

Afghanistan

Djibouti

Egypt

Jordan

Lebanon

Syria

Uzbekistan

Yemen

None of the above

*5.Did you serve at any of these locations on or after August 2, 1990? Check all that apply. (Required.)

Bahrain

Iraq

Kuwait

Oman

Qatar

Saudia Arabia

Somalia

The United Arab Emirates (UAE)

None of the above

*6.Have you been diagnosed with bladder cancer?(Required.)

Yes

No